The headache pills that cause headaches

Reading the British Medical Journal today I saw an item in the ‘news’ section which caught my eye. Entitled ‘Too frequent use of painkillers can cause rather than cure headaches’, it relays information coming from the National Institute of Health and Clinical Excellence (NICE) in the UK. It seems that in some cases, painkilling medication can cause headaches, which in turn can encourage an unhealthy dependence on these drugs.

Dr Martin Underwood, a general practitioner (family physician) and professor of primary care admits in the piece that explaining to patients that they should abruptly stop their treatment and endure weeks of worsened pain was not an easy task. When I read this, I wondered why the withdrawal from the medication need be abrupt. How about g-r-a-d-u-a-l withdrawal?

I have lost count of the number of patients who have been on some sort of medication (blood pressure lowering, hormone replacement therapy, antidepressant, medication for acid reflux, you name it) who had tried to abruptly stop their medication and then found themselves landed in trouble, who went on to have success with a gentler approach. Yes, gradual weaning down over some time (say a few weeks) may take longer, but I’ve found the results are much better overall than sudden stopping.

And while we’re thinking about gradual withdrawal of painkillers, how about also thinking about what might have caused the headaches in the first place, and addressing that at the same time?

I note that NICE classifies headaches into three type: tension, migraine and cluster. This classification reminded me of how often in medicine we are geared up to making the diagnosis, but sometimes fall short regarding what really matters (effective management). Often when talking to patients I will discuss the likely diagnosis and it may even have a fancy name. However, as I sometimes tell my patients, making the right diagnosis is not really the point of the exercise, it’s working out what’s causing the problem and then doing something about it.

Many years ago I was at a social event and ended up talking to a professor of neurology. The subject of migraine came up, and I mentioned that I’d found magnesium supplementation to be useful in the management of this condition. He asked me what the ‘proposed mechanism of action’ of magnesium was. I ventured an explanation, but he wasn’t having any of it. In fact he became quite hostile. I did not take this personally, though, as later in the evening he ended up having a physical fight with an old school ‘friend’ who was at the party. But I digress…

While we were still on the subject of migraine and magnesium, I made the point that the proposed mechanism of action of magnesium was not really important – the important thing is if the magnesium provides relief to migraine sufferers. The professor was not open to line of reasoning, and it reminded me of how some doctors’ priorities seem to have become drawn away from what medicine is really about (helping people).

In case you or someone else is interested, I wrote about the potential value of magnesium in migraines recently here.
I would add that I find this approach to work in people with more common-or-garden ‘tension’ headaches too. Some have suggested that magnesium deficiency can cause tension in muscles, including those in the neck, which can manifest as a headache.

Another simple approach that often works wonders for headaches is ensure adequate hydration. It’s possible that some dehydration will cause a degree of brain shrinkage or some pressure on the brain from its outer covering (known as the ‘meninges’). I don’t know if this is correct or not, but I don’t very much care either seeing as I’ve found improved hydration to be a very useful strategy for curing headaches. I recommend drinking enough water to keep the urine pale yellow and non-odourous throughout the day.

Another quite-common cause of headaches, I find, is caffeine withdrawal. Anyone who has gone ‘cold turkey’ of a good coffee or tea habit is likely to know how this fells (typically the headache comes on within a day and lasts for 1-2 days before resolving – often, for good). It is interesting to note that some headache remedies contain caffeine, despite caffeine having no painkilling properties. Could it be that the manufacturers know that headaches can be caused by caffeine withdrawal and caffeine can therefore help get rid of a headache? But might they also know that putting caffeine in the medication will likely, ultimately, lead to some caffeine withdrawal and another headache requiring, yes, more medication. I have no idea but I think we should at least ask the question. I wrote about this issue some years ago here.

I do hope our friend the professor isn’t reading these ideas about unfounded approaches that have the capacity to genuinely help people, lest he boils over and starts another bout of fisticuffs.

7 Responses to The headache pills that cause headaches

  1. Inger 22 September 2012 at 1:21 am #

    Could you please tell me how much magnesium is present in 2000g magnesium citrate. I have bought a supplement which contains magnesium oxide, magnesium citrate and magnesium gluconate. It states on the bottle that it has the equivalent of 30mg magnesium as the citrate – but how much magnesium citrate is that? In total the tablets contain 200mg magnesium. Thank you.

  2. Inger 22 September 2012 at 1:23 am #

    Apologies for the above – it should be 2000mg magnesium citrate!

  3. Mercy 22 September 2012 at 2:08 am #

    Hello

    I like the idea of finding out the cause and doing something about that. About 18 months ago I was having the most alarming headaches. Pain reaching up from my shoulders to neck, initially and then further to reach the top of my head. A visit to the Doctor gave me a wonderful insight. All she could do was ask me if I’d ever considered the Mirena coil as a contraceptive. This had nothing to do with my head / neck pain – which was making listening to her ramble nonsense really difficult – but to get me off the more expensive depo-provera. I ended up having a dexa scan (i was 34 when I started depo so not in danger of bone malformation ) just because I had a bad headache.

    Happy to report (through internet self diagnosis) a new mattress and pillow has mostly cured the headaches – stress does bring one forth on occasion – and I’m still on the contraceptive of my choice. I would have needed a surgical insertion at the hospital to have had a Mirena coil – Doc DID NOT CARE ENOUGH TO LOOK AT MY MEDICAL RECORDS TO SEE IT WASN’T SUITABLE FOR ME. Daft woman. Shame it took me 6 weeks of conversations with medical nurse at the hospital and deep fear for me to find out I could just go along as I was, getting what worked for me. But heyho.

    They can be really bad for you can Doctors.

    Not Dr Briffa – he’s cool :)

  4. Mercy 22 September 2012 at 3:17 am #

    Headaches? Sorting out the problem works.
    Well, when I was having the immobilising neck to headaches I’d take 2 ibuprofen and 2 paracetamol at the same time. Often this just vaguely numbed the pain for 2 hours. Never felt like anything was working as – trust me – I would take the same again after just 3 hours. All day. Day after day.

    Not being soft in the head, I knew this wasn’t a good thing to do. Then it’d disappear for 2 days. As you know from above, going to the Doctor was pointless :)

    However, once the source of pain was dealt with – by my own devices and a bargain at £450 , I just didn’t need the painkillers any more.

    Once you don’t hurt, you just get on with it. Cos it’s normal.

    Mx

  5. Yang Tjew 23 September 2012 at 8:41 pm #

    I agree that magnesium supplementation and adequate hydration may likely relieve the garden variety of headaches. Wouldn’t massage to tense muscles also relieve tension headaches?

    I suggest your professor friend eat more steak with butter (or bernaise/hollandaise sauce) as that is considered a “comfort” food and leads to improved overall mood satsifaction. Perhaps that can be your next topic of conversation with him?

  6. Kay Nelson 24 September 2012 at 10:09 pm #

    I have recently found that cooling gel strips help ease headaches that I previously would have taken tablets for. Each strip lasts for about 6 hours though I have never needed a second one.

  7. Nadia 29 September 2012 at 10:57 am #

    I frequently used to get headaches, sometimes 2 – 3 a week and if I did not take some ibuprofen or some paracetamol (or whatever I could lay my hands on!!), the headache would inevitably lead to migraines. Without fail, for the next 5 hours I would have to lie in a darkened room, interrupted with trips to the loo to be sick. This started at the age of 7 right through to about 3 years ago….. (I am now 43) when I switched to a low carb diet. The headaches started to go away. Last year I started applying Magnesium Oil to my feet before going to bed. The migraines stopped completely. However, I found that Magnesium Oil really dried the skin on my feet so I started having a Magnesium bath once every couple of weeks or so instead. The concentration is much lower but magnesium is absorbed by every pore on your skin. The only time I get a headache these days is if I’ve had a lot to drink the night before. Fair play really! You have no idea how wonderful it is to be free from the cripling pain of migraines!! And yes, I DID find out about Magnesium here! :-)

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